BCNEPA Creates Efficiencies for Members

March 31, 2010

Efforts Keep Administrative Costs Low

March 31, 2010, Wilkes-Barre, PA — Jennifer Lamoreaux can’t help it. The Blue Cross of Northeastern Pennsylvania major accounts support representative finds herself using her white board all the time to make graphs to track her progress on projects. The habit, Lamoreaux said, is a byproduct of her training during Blue Cross of Northeastern Pennsylvania’s Continuous Process Improvement (CPI) program — a 2-year-old effort to teach employees across the company to be efficiency experts.

BCNEPA’s use of the “Lean” CPI method is one more recent example of the company’s ongoing efforts to keep administrative expenses as low as possible in the face of rising health care costs. BCNEPA began working with the Lean CPI method, which is based on the Japanese concept of “Kaizen” or “good change,” in April 2008 to encourage employees to find savings for members. That’s when BCNEPA’s Board of Directors inspired the formation of a workgroup to spearhead the improvement initiatives, which are used by hospitals and manufacturers such as car makers.

In just 22 months, company leaders have trained 166 employees and 15 “facilitators” or coaches to use the special improvement method. Employees have initiated 45 CPI projects, and scheduled more for this year. In total, the CPI projects completed in 2008 and 2009 helped employees use 30,000 hours of work time more efficiently, which is the equivalent of approximately $600,000 in savings. The projects have led to several improvements, including allowing customer service representatives to field additional benefits inquiry calls each month, accelerating payments to providers and expediting the subscriber appeals process.

The Lean CPI method trains employees to be more productive with existing resources by finding and eliminating unnecessary steps in the work they do each day. Each CPI-trained worker undergoes a half-day educational session before tackling a company improvement project under the supervision of an employee trained to be a CPI facilitator. By recognizing and eliminating inefficiencies, employees are able to improve BCNEPA’s administrative costs, which are already among the lowest in the industry.

BCNEPA spends slightly more than 90 cents of every premium dollar on health care costs even as they rise due to subscribers using more medical care and providers seeking higher reimbursements, said Denise Cesare, BCNEPA’s President and CEO.

“In health care, managing costs has been a continual challenge, but we have historically implemented various initiatives to be more efficient and effective,” Cesare added. “BCNEPA’s use of the Continuous Process Improvement method is one more way we work to provide the most affordable, accessible, high-quality coverage to our members.”

So far, successful CPI projects have:

Simplified Explanation of Benefit forms, reducing member calls by 25 percent per month.

Helped customer service representatives to field 397 more benefits calls per month.

Accelerated payments to providers.

Expedited the subscriber appeals process.

Streamlined the process to enroll new members.

Sped up the process of entering newly credentialed providers into BCNEPA’s network.

Decreased the average turnaround time for processing certain claims.

Bettered the bariatric surgery review process.

Improved the system used to identify providers in BCNEPA’s network.

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About Blue Cross of Northeastern Pennsylvania

Blue Cross of Northeastern Pennsylvania is an independent licensee of the Blue Cross and Blue Shield Association headquartered in Wilkes-Barre. It offers a comprehensive portfolio of health insurance products and administrative services to approximately 600,000 individuals in 13 counties in northeastern and north central Pennsylvania. The company’s mission is to provide innovative solutions that support more affordable health care, promote personal accountability for health and wellness, and offer superior service and partnership to employers, members, and providers.